While the typical obstructive sleep apnea (OSA) patient is pictured as a heavyset male with a bulky neck, who is over the age of 40 and has a snore that could raise the roof, there are other sleep apnea causes. Therefore, sleep apnea and obesity do not represent the entire demographic of individuals who suffer with this sleeping disorder, people with sleep apnea all shapes and sizes.
Can You Have Sleep Apnea and Be Thin?
Although being overweight or obese increases the likelihood that an individual will develop sleep apnea, those suffering with this disorder come in every shape, size, gender and race. In addition, many of the people who have sleep apnea are neither overweight nor obese. However, due to the stereotypical characteristics of sleep apnea and obesity, those with this disorder who are not overweight are under-diagnosed and under-served.
Understanding Obstructive Sleep Apnea
Obstructive sleep apnea is a breathing disorder that occurs during sleep. Apnea (cessation in breathing) occurs when there is an obstruction (blockage) interrupting the flow of air into the pharynx (airway). This obstruction may be caused by enlarged adenoids and/or tonsils or the collapsing of the throat muscles with the tongue falling back into the airway; thus, causing the blockage.
Once the airway becomes obstructed, the brain awakens to signal the respiratory system to resume breathing. Once breathing resumes, the body may jerk, a loud gasp and/or a snort may cause the individual to wake up momentarily. As the individual is awakened numerous times during the night, his or her mind and body do not receive the rest that is necessary to function properly; consequently, causing the individual to feel fatigued throughout the day.
Other Sleep Apnea Causes
A variety of other issues can cause sleep apnea.
These issues include:
- Retrognathia (Recessed Jaw) – this condition is frequently referred to as an 'overbite' and is characterized by the mandible (lower jaw) being set back from the maxilla (upper jaw). When an individual has this condition, it does not necessarily mean that his or her mandible is too small. It just means that when viewing the profile of the face, the mandible appears recessed. It is this recessed position of the jaw that allows the tongue to fall back during sleep and block the airway. The structure of one’s face is based in part on an individual’s genetics. So, retrognathia can be inherited. In addition, some type of facial trauma during early childhood can cause the jaw to become displaced. This jaw displacement frequently results in an uneven, set back appearance.
- Micrognathia – this condition is characterized by a mandible that is too small. Since the mandible is too small, it blocks the pharynx and interrupts the normal breathing pattern, which causes sleep apnea. There are several rare genetic conditions responsible for causing severe jaw malformations such as this.
- An Elongated Soft Palate – an extra-long soft palate may cause OSA because it narrows the opening between the pharynx and nasopharynx levels. In addition, an enlarged or swollen uvula (the pendulous tissue that hangs down at the back of the throat) can compromise the airway. An elongated soft palate and uvula can both be inherited traits; however, a swollen uvula can also be caused by acid reflux, injury to the throat or the uvula, or a dry mouth.
- A High-Arched Palate (High-Vaulted Palate) – this refers to the hard palate located on the roof of the mouth. When an individual has a high-arched palate, the roof of his or her mouth is unusually narrow and tall. This developmental feature can occur singularly or in conjunction with a variety of other conditions. In addition, a high-arched palate can be caused by thumb-sucking. A high-vaulted palate can cause obstructive sleep apnea by narrowing the airway during sleep.
- Poor Muscle Tone in the Throat and Tongue – if the muscles become too relaxed due to the consumption of alcohol or the use of medications that cause drowsiness, the tongue may fall to the back of the throat and into the pharynx or the muscles of the throat can draw in from each side, compressing the airway.
- Obstructions Affecting the Nasal Airways – when an individual has a stuffed-up nose, extra effort is required to pull air through: This extra suction causes the floppy tissues of the throat to pull together, which produces a snore. In addition, deformities of the nasal septum or nose can cause an obstruction. These deformities include a deviated septum: A deviated septum is a deformity of the wall separating the nostrils.
- Enlarged Tonsils and Adenoids – these conditions may occur due to repeated infections. The infections may be viral (e.g., cold) or bacterial (e.g., streptococcal pharyngitis). Other reasons for enlarged tonsils and/or adenoids include allergies, acid reflux and irritants (e.g., smoke, exhaust, etc.). When enlarged, the tonsils can interfere with one’s ability to swallow and breathe. Enlarged adenoids may block the eustachian tubes (which connect the ears to the back of the throat).
Some of the Dangers of Sleep Deprivation
Needless to say, individuals who have sleep apnea do not sleep well, which is why they suffer with daytime drowsiness. Although one may disregard the everyday symptoms of OSA as just bothersome, neglecting to seek treatment could lead to serious consequences.
Sleep Deprivation Can:
- Increase an individual’s risk of developing heart disease, Alzheimer’s, type 2 diabetes and becoming obese: Rest in the form of sleep is essential because it allows the body to control the appetite and the metabolism through the secretion of hormones. In addition, the body processes glucose during this time. Poor sleep can cause an increase in cortisol production. Cortisol is the stress hormone responsible for causing an accumulation of fat in the stomach and around the waist. In addition, less insulin is released following a meal: This in conjunction with the increase in cortisol production can lead to an excess of glucose in the blood, which is what increases the likelihood that the individual will develop type 2 diabetes.
- Weaken the immune system, which makes fighting off even the common cold challenging: Sleep deprivation causes a decrease in the number of white blood cells ('natural killer cells') in the body. These cells are responsible for killing viruses and tumors. The depletion of these natural killer cells makes it harder for the body to fight off illnesses.
5 Tips for Choosing a Sleep Lab
Individuals who think they have sleep apnea, need to undergo a sleep study. Health insurance companies will typically pay for these studies; however, patients should always contact their insurance company to find out what their policy actually covers prior to scheduling an appointment. In addition, to attain the highest benefit amount possible, patients may need to choose a sleep study lab that is within their network. Once the patient knows where he or she stands with the insurance, it is time to find a lab.
1. Make Sure the Sleep Lab is Accredited
Patients should visit sleepeducation.org/find-a-facility to ensure the lab they are considering is accredited by the American Academy of Sleep Medicine (AASM). When a sleep lab is accredited, the testing staff is trained in polysomno-graphic technology and the director is a board-certified sleep physician.
2. Check Their Hours
Patients who work a variety of shifts or who are night owls may find it difficult to fall asleep on demand. This can be an issue at some of the smaller labs that only conduct studies from 10 p.m. to 5 a.m.; therefore, find a sleep lab that offers an array of testing times.
3. Expert Consultations are Key
The best sleep labs have medical experts like pulmonologists, neurologists and psychiatrists that they can utilize to diagnose the reason an individual is suffering with obstructive sleep apnea.
4. The Mask Must Fit Properly
If the patient is diagnosed with OSA, a CPAP (continuous positive airway pressure) titration test will be required. This test helps determine the minimum amount of air pressure that is necessary to keep the patient’s airway open. The lab must have access to masks of different sizes and styles.
5. Comfort Level is Key
Sleeping in a strange place is hard enough; therefore, feeling as comfortable as possible is essential. Choose a sleep lab with a bedroom that resembles a hotel. Make sure the test equipment makes moving around easy.
If you or your child have already been diagnosed with mild to moderate obstructive sleep apnea, you may want to try an oral appliance as a first line therapy for sleep apnea. If you believe that you or your child has OSA, but you do not have a diagnosis as of yet, contact an accredited sleep lab to schedule a sleep study. A diagnosis of mild or moderate obstructive sleep apnea can usually be treated using an oral appliance as opposed to a CPAP machine.